Table 1

Summary of the lessons learnt

1. Minimum technological infrastructureAdequate digital infrastructure with robust internet connection; appropriate hardware and softwareThis includes a robust and reliable broadband internet connection. Maintaining stable bandwidth and network speed can be challenging in rural areas and must be secured before implementing telemedicine. appropriate hardware and software are other critical components. Telemedicine hardware pieces must be mobile and easy to operate in a clinical setting. the software must be well integrated with the existing and future platforms, not interrupting the workflow, and secure future interoperability as the number of telemedical programmes using electronic medical record systems grows. governments, particularly in low and middle income countries (LMICs), must account for the license and maintenance fees to make telemedicine sustainable.
2. Local championsEnthusiastic medical staff promoting the adoption of telemedical technologyLocal champions need to possess sufficient knowledge of the adopted technology, an understanding of the implementing organisation and the ability to establish credibility among peers7 8. An integrative review of champions in healthcare found them among critical factors in project implementation success9. In our case, a small group of committed English-speaking doctors at the RRCEM operated as local champions. They ran the programme on the Uzbekistani side, participated in regular ward rounds with German counterparts, served as multiplicators for education and training, and promoted and legitimised the new approach.
3. Trust among partnersTrust and commitment among clinical partners engaged in joint telemedical activitiesIn cross-border telemedical networks, mutual understanding of respective healthcare systems and sociocultural aspects of care between the ‘hub’ and the ‘spoke’ are crucial and achieved through dedication and regular communication. In our case, we followed what a hybrid model of care mixing on-site missions with virtual care. Initially, German doctors stayed at Tashkent hospital to support the treatment of critically ill patients. On return, project coordinators in Germany organised a weekly online course on the fundamentals of intensive care medicine between the Charité and RRCEM before the launch of the tele-ICU. The colleagues from both hospitals learnt the specifics of the respective clinical environments by discussing clinical cases and protocols. This combination of on-site and online meetings helped building rapport and prepared colleagues for long-term telemedical work.
4. Human resourcesTraining programmes to create a sustainable telemedical workforceNot all staff members may be ready to adopt telemedical technology. Greater engagement with young healthcare professionals is necessary to address this, given their enthusiasm to use new technologies.10 Another hindrance is a high workload at the hospital, which could hamper clinicians’ ability to learn using novel devices and limit the time for telemedicine. During teleconsultations, recurring technological issues can decrease their effectiveness and impede the willingness to engage with telemedical technology.11 Combining a blended learning concept with an e-learning part and on-site visits is an efficient way to promote staff training.
5. Governance and leadershipCommitment, support and encouragement of the leadership in the implementation of telemedical projectsDecision-makers, such as the Ministries of Health, must prioritise digital health and promote the use of digital technologies to create more equitable healthcare. Leadership must ensure an appropriate legal framework for conducting joint telemedical rounds, including the matter of licence to practice. Our project received full support from the hospital management, and the Ministries in both countries endorsed it. An international consultancy agreement clarified the making of treatment decisions between two teams.
  • RRCEM, Republican Research Centre for Emergency Medicine; tele-ICU, telemedical intensive care unit.